Healthcare Provider Details

I. General information

NPI: 1376925883
Provider Name (Legal Business Name): DEBORAH ANN GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11215 W NEVADA AVE STE C
YOUNGTOWN AZ
85363-1244
US

IV. Provider business mailing address

2445 W SILVER SAGE LN
PHOENIX AZ
85085-5740
US

V. Phone/Fax

Practice location:
  • Phone: 623-847-8839
  • Fax: 623-847-8838
Mailing address:
  • Phone: 623-847-8839
  • Fax: 623-847-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: